This is a case report of a patient with left ventricular free wall rupture after acute myocardial infarction that was managed successfully with the use of an extracorporeal membrane oxygenation circuit for resuscitation, surgical repair and postoperative circulatory support. Conversion to conventional cardiopulmonary bypass for surgical repair was avoided. Decompression of the left ventricle during the postoperative period promotes myocardial recovery and leads to improved fixation of surgical repair.